CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Sky Lakes Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $19,733
Cash Discount Price: $61,504
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Sky Lakes Medical Center is $19,733. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61,504. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.41x the Medicare baseline. Located in 2865 Daggett Avenue, Klamath Falls, OR.

Cash / Self-Pay

$61,504

Average discount available for prompt cash payment at this facility.

Insurance Median

$19,733

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $61,504 (438%)

Insurance Median: $19,733 (141%)

Cash: $61,504 (438% of Medicare)

Ins. Median: $19,733 (141% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Cco Cascade Health Alliance [5006]	$10,415	74%
Medicare (plans)	$19,268 - $19,733	137%
Kaiser Med Adv HMO [7027]	$19,733	141%
Regence Medadvantage [7017]	$19,733	141%
Humana	$19,733	141%
Cigna	$19,733	141%
Pyramid Todays Option Premier [7015]	$19,733	141%
Kaiser Med Adv Oregon HMO [7009]	$19,733	141%
Managed Hlth Netwrk Bh Wellcare [7042]	$19,733	141%
Pacificsource Med Adv HMO [7035]	$19,733	141%
Pacificsource Med Adv PPO [7018]	$19,733	141%
Aetna	$19,733	141%
Samaritan Health Med Adv HMO [7043]	$19,733	141%
Allcare Advantage [7006]	$19,733	141%
Blue Cross Blue Shield	$19,733 - $44,835	141%
Kaiser Med Adv Senior Nw [7028]	$19,733	141%
Kaiser Med Adv So California HMO [7038]	$19,733	141%
Kaiser Med Adv No California HMO [7037]	$19,733	141%
Wellcare Healthnet Med Adv PPO [7023]	$19,733	141%
UnitedHealthcare	$19,733	141%
Alignment Health Plan [7029]	$19,733	141%
Wellcare Healthnet Med Adv HMO [7022]	$19,733	141%
Scan Health Plan [7024]	$19,733	141%
Moda Health [1070]	$26,000	185%
Providence Health Plan [1078]	$31,048	221%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $61,504.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sky Lakes Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.